Key result
Transcatheter aortic valve implantation using a 29-mm Corevalve bioprosthesis via the left common carotid artery was successfully performed without access-site complications in a 90-year-old woman.
Why the study?
Can transcatheter aortic valve implantation be safely performed via the left common carotid artery when classical access routes are unavailable?
Case Report (n=1)
Can transcatheter aortic valve implantation be safely performed via the left common carotid artery when classical access routes are unavailable?
The left common carotid artery may serve as a viable alternative access route for transcatheter aortic valve implantation in elderly patients when femoral and subclavian routes are precluded by vascular lesions.
Answers are grounded in this paper and cite their sources.
Carotid access may be feasible when femoral/subclavian routes are precluded; hypothesis-generating and requires prospective validation before wider use.
A 90-year-old woman with symptomatic degenerative aortic stenosis had a logistic Euroscore greater than 53.29%, indicating a high surgical risk. She was therefore advised to undergo transcatheter aortic valve implantation. Both iliac arteries showed subocclusive calcifications, and the left subclavian artery was narrow and calcified. The left common carotid (LCC) artery was chosen as the access route. After surgical exposure of the LCC artery, the Corevalve Revalving 29-mm bioprosthesis was implanted successfully. No access-site complications occurred. In our experience, a substantial proportion of elderly patients have vascular lesions precluding use of the femoral route. Brachiocephalic access routes may be valuable when no other options are available.
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Mouillet et al. (2011) conducted a case report in Symptomatic degenerative aortic stenosis (n=1). Transcatheter aortic valve implantation via left common carotid artery was evaluated on Procedural success and access-site complications. Transcatheter aortic valve implantation using a 29-mm Corevalve bioprosthesis via the left common carotid artery was successfully performed without access-site complications in a 90-year-old woman.
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